Feline non-regenerative immune-mediated anaemia: features and outcome in 15 cases

Victoria Black; Sophie Adamantos; Dominic Barfield; Séverine Tasker

doi:10.1177/1098612X15588800

Feline non-regenerative immune-mediated anaemia: features and outcome in 15 cases

J Feline Med Surg. 2016 Aug;18(8):597-602. doi: 10.1177/1098612X15588800. Epub 2015 Jun 26.

Authors

Victoria Black¹, Sophie Adamantos², Dominic Barfield³, Séverine Tasker²

Affiliations

¹ The Feline Centre, Langford Veterinary Services, University of Bristol, Langford, UK v.black@bristol.ac.uk.
² The Feline Centre, Langford Veterinary Services, University of Bristol, Langford, UK.
³ Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, UK.

PMID: 26116621
DOI: 10.1177/1098612X15588800

Abstract

Objectives: Pure red cell aplasia (PRCA) and non-regenerative immune-mediated haemolytic anaemia (NRIMHA) are uncommon causes of non-regenerative anaemia affecting the bone marrow in the cat. This retrospective study aimed to describe the clinical features, treatment and outcome (remission and survival) of cats with these disorders.

Methods: Cases of PRCA and NRIMHA presenting between 2009 and 2013 were retrieved. Clinical features including signalment, history, clinical signs and diagnostic investigations were recorded, as well as treatment(s) used and outcome (remission and survival). Outcome was compared for PRCA and NRIMHA.

Results: Fifteen cats met inclusion criteria: seven with PRCA and eight with NRIMHA. The majority (12/15) were younger than 3 years of age. Volume overload was common (8/11). Treatment with whole blood transfusions with or without Oxyglobin was necessary in most cats (14/15) and resulted in congestive heart failure in one cat. Most cats (11/15) achieved remission 12-42 days after starting immunosuppressive treatment. Treatment protocols associated with remission were glucocorticoids alone (remission in 6/7 cats), glucocorticoids and chlorambucil (remission in 3/6 treated cats), glucocorticoids and ciclosporin (one cat only) and ciclosporin alone (one cat only). Relapse was observed in 3/11 cats, and 8/11 cats were still receiving treatment at the time of follow-up. Outcome (remission and survival) did not differ between PRCA and NRIMHA.

Conclusions and relevance: PRCA and NRIMHA are uncommon causes of anaemia in predominantly young cats. The prognosis is reasonable, with a mortality rate of 27%, and it can take at least 6 weeks before remission is observed. Following clinical remission, gradual withdrawal of immunosuppressive treatments should be attempted, with close monitoring for relapse; some cats may require long-term treatment. This study is the first to report the use of chlorambucil as an adjunctive immunosuppressant in these cases. Outcome did not differ for PRCA and NRIMHA.

MeSH terms

Animals
Blood Transfusion
Cat Diseases / diagnosis*
Cat Diseases / therapy*
Cats
Prognosis
Red-Cell Aplasia, Pure / diagnosis
Red-Cell Aplasia, Pure / therapy
Red-Cell Aplasia, Pure / veterinary*
Retrospective Studies
Treatment Outcome